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1.        PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pol.:  12

Inc Town:  IRVINGTON

City:  IRVINGTON

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  5312

File No.  3258

Registered No:  

2.        FULL NAME:  BELL, JOHN TAYLOR

PERSONAL AND STATICAL PARTICULARS

3.        SEX:  MALE

4.        COLOR OR RACE:  WHITE

5.        SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED

6.        DATE OF BIRTH:  HARDINSBURG, DEC 20, 1872

7.        AGE  (yr. mo. da) (If less than 1 day, hours or min?):  38 / - / 16

8.        OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER

(b.)  General nature of industry business or establishment which employed:  

9.        BIRTHPLACE:  BRECKINRIDGE

10.     NAME OF FATHER:  W.B. BELL

11.     BIRTHPLACE OF FATHER:  KENTUKCY

12.     MAIDEN NAME OF MOTHER:  NANCY KENNEDY

13.     BIRTHPLACE OF MOTHER:  KENTUCKY

14.     THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)  J.T. BELL

(Address)  IRVINGTON

15.     Filed  JAN 14, 1911

REGISTAR:  D.W. HENRY

MEDICAL CERTIFICATE OF DEATH

16.     DATE OF DEATH:  JAN 5, 1911

17.     I HEREBY CERTIFY, That I attended deceased from (date):  JAN 4, 1911 to JAN 5, 1911

That I last saw him/her alive on (date):  JAN 5, 1911

And that death occurred on the date stated above at (time AM/PM):  3 AM

THE CAUSE OF DEATH was as follows:  ACUTE INDIGESTION

 

(Duration)   Years:            Months:            Days:  1

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  S.P. PARKS

Date:  JAN 5, 1911

Address:  IRVINGTON

18.     LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)

At place of death (yr, mo, da.):  

In the State (yr, mo, da):  

Where was disease contracted,  if not at place of death?  

Former or usual residence:  

19.     PLACE OF BURIAL OR REMOVAL:  FREEDOM

DATE OF BURIAL:  JAN 5, 1911

20.     UNDERTAKER:  G.T. MARSHALL & SONS

ADDRESS:  IRVINGTON


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Copyright.  All rights reserved.
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